Polite Dissent

Adventures of Superman #642 “Sacrifice, part 3: Remembrance”
Greg Rucka, writer
Karl Kerschl, Derec Donovan, Cam Smith and Sean Parsons, artists

Superman: I’m listening to him…to the sound of his ribs crushing in when they should be moving out. Moving out when they should be moving in…

…to the hiss of supplemental oxygen at twelve liters per minute, forcing it’s way into his blood…

…to the drip of the plasma into his veins…

Batman was badly injured in a recent fight aboard the JLA watchtower. He’s experiencing paradoxical chest movement which means that part of the chest is moving backwards: out with exhalation and in with inhalation. This tells us that Batman has a flail chest. Flail chest is common in blunt trauma and occurs when a group of ribs are each broken in two places so that they are no longer tethered to the rest of the chest wall. The best treatment for flail chest is good pain management and ensuring that the lungs work well. Sometimes surgical correction is required, though it seems that the “Healing Ray” used by Wonder Woman (that looks like it comes from a frying pan) is quite effective too.

12 liters-per-minute is a lot of supplemental oxygen. The JLA must be using a high flow system, such as a Venturi mask. These are not normally used in trauma situations (usually only in people with severe underlying lung conditions like bad emphysema), but in this case it’s probably being used because of his flail chest and underlying lung damage. Or it could be some high tech Thanagarian system — it does look more like a fighter pilot’s mask than a medical mask…

Plasma is not used for fluid resuscitation; it is only given when people have clotting disorders. Batman needs blood, not plasma (and the artist gets it right, drawing red blood in the IV, not pale yellow plasma).

Finally, a nit pick about trauma medicine. I’ve talked before about the ABCs of emergency medicine (Airway, Breathing and Circulation). In trauma situations, there is also a D and E. D stands for Disability: perform a quick neurological exam to look for any nerve damage. E stands for Exposure: undress the patient and make sure there are no hidden injuries. Even a small missed injury can spell big problems later. You’ll notice that Batman is still wearing his costume — in fact he has a bandage over parts of it. The rescue team seems to have missed the E step. Where’s Dr. Mid-Nite when you need him?